It is 10.25am on a Friday and I am Googling “online pharmacies”. I have a mild infection and I weigh up whether talking to an AI doctor will be more efficient than queueing at my GP surgery before the weekend. After a seven-minute multiple-choice questionnaire, I am deemed eligible for antibiotics: a single sachet is £43. I close the page and consider spending the cash self-medicating with a family-size Uber Eats instead.
I thought of this later as I read the news that half of millennials in the UK are planning to use private healthcare in the next year. A survey by the Independent Healthcare Provider Network found that those aged 34 to 44 were the most likely age group to go private. Forty-nine per cent said they were likely to use it in the next 12 months, with young professionals increasingly opting for employment with medical insurance. Forget career progression or annual leave, nowadays jobseekers want eye tests and cancer checks.
As a millennial with the long-term health conditions of a boomer, I can identify with this mindset. I’ve always been ideologically against private healthcare, to the extent that when that Bupa advert comes on the TV where the woman in remission from cancer dances joyfully, I involuntarily yell: “Parasites! Did she have to sell her home to pay for chemotherapy?!” But with NHS waiting lists still sky high, like many, I’ve found myself relying on private healthcare for the first time. When I had nerve damage in my arm and was struggling to type this column, I reluctantly booked an appointment with a private physiotherapist rather than waiting several months on the NHS. Without private insurance, I paid the £75 an hour cost and felt lucky that I could afford to.
This is clearly a problem for the individual: a generation who entered the workforce during a global recession and has to pay astronomical costs for house deposits and childcare is now expected to find cash for healthcare too. But it is also a problem for the rest of society: a 40-year-old who will probably pay taxes for the next 25 years but already doesn’t feel as if they get enough from the NHS will be less invested in the service in the future, and at worst, resentful in light of intergenerational inequality and an ageing population they will need to support.
The government knows it. In a speech this summer, the health secretary, Wes Streeting, warned that younger people “opting out” of the NHS and going private “presents an existential risk to the health service”. “The NHS feels increasingly slow and outdated to the generation that organises their lives at the touch of a button,” he said. “If you get annoyed at Deliveroo not getting your dinner to you in less than an hour, how will you feel being told to wait a year for a knee operation?”
There is some truth to Streeting’s statement: a demographic that is tech savvy and can organise their social and professional lives on demand feel particularly put off by a healthcare system in which they have to call a landline at 8am to book an appointment or wait for the post to tell them about a scan in nine months. When I went private for physio, I was struck by the flexibility and patient-led focus: while the NHS often struggles to provide an appointment at a time that’s accessible to my chronic fatigue (and is openly baffled by the request), the private clinic was happy to do it in two halves to fit with my energy levels.
But it is disingenuous – and a distraction – to suggest that the shift to private provision is about a craving for choice or even quicker care, as if millennials are Carrie Bradshaw shopping around for high-end healthcare. In the survey by the Independent Healthcare Provider Network, nearly half of respondents cited difficulties getting an NHS appointment at all as the main reason for using private healthcare. One in 10 said they did so because their NHS appointment was outright cancelled or postponed. For many, going private isn’t about wanting a choice – it’s a reflection of the fact a creaking NHS means they increasingly don’t have one.
When we talk about the encroachment of private companies on the universal healthcare model, we tend to hear about the logistics: the NHS now outsources nearly £3.5bn of procedures to private hospitals to help speed up waiting lists, despite most doctors who do the private surgeries being siphoned off from the NHS.
And yet the issue is also our political culture – one that nudges the public ever closer to accepting private healthcare as a necessity rather than a luxury. Whether it is Nigel Farage floating the idea of a mix of private and public healthcare or Tony Blair advocating for “an expanded role” for private firms, the strategy is clear enough: starve the NHS of resources, and drive down the quality and availability of the service, and patients will get used to looking elsewhere. That younger people increasingly treat employer health insurance as a requirement rather than a perk shows how effective this cultural shift has been: a US-style connection between work and health means medical care can be viewed bit by bit not as a right for all, but a privilege for the LinkedIn few.
We have already seen this with dentistry, with it becoming the norm in recent years for patients to be left without an NHS dentist even for critical care. The end result is a lesson in what happens when universal coverage disappears: private dentists have hiked up their prices, while record numbers of people are turning to dental insurance and those without cover pull out their own teeth.
In the end, I braved the GP’s surgery. The process was reassuring in its mundanity: a short wait on the phone, a 10-minute call, then a prescription bought with a pre-payment certificate at no extra cost. If it wasn’t too on the nose, I would suggest every doctor’s surgery in the country changes its hold music to Big Yellow Taxi by Joni Mitchell. “Don’t it always seem to go / That you don’t know what you’ve got till it’s gone …”
Frances Ryan is a Guardian columnist. She is the author of Who Wants Normal? The Disabled Girls’ Guide to Life
